Patient safety is the avoidance of unintended or unexpected harm to people during the provision of health care. Anaesthetists have been leaders in patient safety for decades. In the United Kingdom, wholesale reform of children’s surgical delivery was undertaken after review of paediatric surgical outcomes in the 1990s, and in cardiac surgery, after an anaesthetist noted poor patient outcomes in children undergoing the arterial switch operation (see Kennedy 1996 in ‘Further Reading’).

Various hospitals in the US and around the world suffer from the well-known problem of emergency department (ED) overcrowding, which prevents them from serving patients effectively and efficiently. An important contributor to this problem, which became even more dire after the COVID-19 pandemic, is prolonged boarding of patients who are admitted to inpatient units through the ED. Patients admitted through the ED constitute about 50% of all nonobstetrical hospital admissions in the US, and they may be boarded in the ED for long hours with the hope of finding an available bed in their primary inpatient unit. This chapter sheds light on effective ways of reducing ED boarding times by considering the trade-off between keeping patients in the ED and assigning them to a secondary inpatient unit. Using simulation analyses calibrated with hospital data, they find that implementing this policy could significantly help hospitals to improve their patient safety by reducing boarding times while controlling the overflow of patients to secondary units. Using data analyses and various simulation experiments, they also help hospital administrators by generating insights into hospital conditions under which achievable improvements are significant.

The Patient Safety Incident Response Framework is a new NHS-mandated approach to incident reporting. This chapter provides a brief overview with the aim of allowing readers to have an initial baseline knowledge of a framework with which they will have to work in the coming years.

The design of the anesthesia workspace can have an enormous impact on errors, patient safety, and outcomes. Human-centered design (HCD) is a multidisciplinary field focused on how to design spaces and tools to maximize human performance. Bringing the lessons from HCD to the anesthesia workspace can improve patient safety and make clinicians more effective. Two medication safety projects at Seattle Children’s Hospital, new medication trays and a medication template, help to demonstrate how to deploy design principles in the operating room. Future improvements in patient safety in anesthesia will rely upon how providers interact with information systems, clinical tools, and one another, and the quality of these interactions is profoundly influenced by how these systems are designed.

Poor quality of care is a leading cause of excess morbidity and mortality in low- and middle- income countries (L&MICs). Improving the quality of health care is complex, yet the health care sector has benefitted from many experiences in other industries and developed its own approaches to quality improvement (QI). It is challenging to identify what works in each situation, make the intended improvements, and ensure it is well measured and sustained. Yet there are several examples from L&MICs that offer a lot of learning and illustrate those factors that underpin successful experiences in QI. This Chapter looks at the evolution of QI in health care over time; the types of health care QI approaches, and their relationship with patient safety and UHC; the opportunities to address the commonly occurring health care quality and safety challenges, as well as what works or does not work in L&MICs.

This chapter explore human factors, also known as ergonomics, which is an established scientific discipline that has become integral in healthcare in recent years. The catalyst for this in the UK was the Clinical Human Factors Group led by Martin Bromiley. Martin’s wife Elaine died following errors made during a routine operation when the theatre team failed to respond appropriately to an unanticipated anaesthetic emergency in part because of a variety of human factors. There is still confusion around the term ‘human factors’. This is partly because human factors cannot be explored in isolation but need to be understood in the context of human activity, error, and the culture around error.

This chapter explains the aims of patient positioning and the complications that can arise from incorrectly positioning patients as well as the physiological changes different positions can cause. The correct positioning and alignment of limbs for surgical procedures is vital, and all perioperative practitioners should understand their role and responsibility for safe patient positioning, and the rationale for it. Safe patient positioning is always a multidisciplinary team effort, whereby all members of the perioperative team should be present in the operating theatre at the crucial moment.

In the immediate post-anaesthesia phase the patient’s airway, breathing, and circulation are subject to dynamic change as the effects of anaesthesia begin to wear off. If not carefully managed, life threatening complications can occur rapidly. The experienced practitioner uses risk appraisal to inform physical assessment in order to pre-empt complications or correct them if they occur. This chapter focuses on the key priorities of assessment together with other essential factors such as pain control.

Care is a fundamental principle that is at the centre of operating department practice. It involves consideration of the patients‘ physical, psychological, and emotional needs whilst respecting their social and cultural beliefs. Perioperative care is not a single event but rather a process that starts with the assessment of patient needs and identification of risks, which are then planned for, implemented, and evaluated as the patient moves through each stage of their journey. The whole process is documented using the framework of a nursing model and perioperative practitioners become experienced in prompt care planning to ensure that the care delivered is safe, effective, and responsive. All perioperative practitioners are responsible for the care they deliver through a duty of care to their employer and the patient. Registered practitioners are also accountable to their regulatory body who set the standards for education and practice. Reflection, as part of continuing professional development, allows practitioners to gain a deeper understanding of the care they provide.

This chapter explains the fundamental aspects of decontamination and sterilisation. A working knowledge of the principles of sterilisation, disinfection, and infection control are essential for effective and safe perioperative practice. Decontamination is defined as the combination of methods—including cleaning, disinfection, and sterilisation—used to make a reusable item safe for further use on patients and for handling by staff. The term refers to the whole cycle, including processes such as cleaning, disinfection, and sterilisation. Aseptic techniques are fundamental to supporting a safe environment and to ensure patient and staff safety with regards to infection and its associated risks. It is essential that perioperative practitioners adhere to national and local standards and understand how the decontamination cycle can mitigate the risk of infection.

The primary purpose of the anaesthetic machine is to deliver anaesthetic gases and volatile agents safely to the patient - helping to maintain a suitable level of consciousness and analgesia for surgery. It is vital that any clinician checking and using an anaesthetic machine is familiar with the type of machine they are intending to use and possess a detailed knowledge of how it operates. Machines must be rigorously checked and tested by a suitably trained person before use and a breathing circuit check should take place between each patient. This chapter is an introduction to the anaesthetic machine, highlighting the main components and features that are essential to maintaining user and patient safety.